Saturday, January 21, 2012

In America Freudian psychoanalysis is on life support. At best, it is a charming relic of a bygone age.

In France psychoanalysis is alive and well. Thanks to Jacques Lacan nearly all French psychiatrists have suffered the influence of Freudian psychoanalysis.

While France has never stinted on psychiatric medication the dominant modes of psychological treatment for mental illness all involve some version of Freudian psychoanalysis.

French psychoanalysis is a hermeneutically sealed world where presumably intelligent people spin out narratives that pretend to tell you all you ever wanted to know about human behavior.

Most of the time the analysts do not pretend that their theoretical fabulations produce good clinical results. The more sophisticated among them do not even believe in clinical results.

Some of you may know that I have more than a passing familiarity with the French psychoanalytic scene. I was a part of it for many years. Two decades ago I departed from it. I have been warning people away from it ever since. I make no claim to objectivity here.

I mention this to preface an amazing story, one that shows the dark side of French psychoanalysis. It has caused considerable chagrin in the French psychoanalytic community.

Two days ago the New York Times reported on the controversy that has erupted around a documentary film produced by one Sophie Robert. See also Robert’s website here.

Robert decided to examine the way autistic children are treated by the psychiatric establishment in France. She compared the clinical results achieved by one child whose parents chose an American behavioral technique called PECS and another child who had been treated with psychoanalytically-inspired methods as a day patient in a psychiatric clinic.

For the record: PECS stands for Picture Exchange Communication System. It works to help autistic children learn to use language.

The film notes at the beginning that autism is generally considered a neurological condition. In the distant American past Bruno Bettleheim attempted to treat autistic children with a variant of psychoanalysis, to little avail. His work has long since been discredited on this side of the Atlantic.

He still has a following in France, and his work, coupled with Freudian theory, has caused French psychoanalysts to believe that, even if autism is a neurological condition, its root cause is psychogenic.

In everyday language, this means that mothers are to blame. If you watch Robert’s film and listen to the various French psychoanalysts proudly offer up their theoretical narratives about autism we discover that they believe it is either caused in utero by a mother’s depression, or by bad mothering.

The psychoanalysts indict mothers for being too close or too distant, too warm or too cold. In any case a mother's bad parenting skills or psychological defects are the root cause of her child’s autism.

For the record some of the psychoanalysts belong to the Lacanian School where I trained. Others belong to French psychoanalytic groups that are part of the International Psychoanalytic Association, the IPA. Most of the important psychoanalytic societies in America belong to the IPA.

When it comes to treating autism the psychoanalysts do not seem to have very much to offer. It is difficult to conduct a talking cure with a child who cannot talk.

But they do not seem to be especially bothered by the inconvenience. A couple of them seem to think that a silent patient constitutes a special challenge to their fortitude as psychoanalysts. They see themselves being challenged to listen attentively to a patient who is incapable of talking.

When the interviewer asks these psychoanalysts what they would consider to be a good treatment result, they themselves are rendered speechless. They act as though the question has never crossed their minds.

French psychoanalysts have been cured of any obligation to provide treatment for their patients.

The film has caused more than a scandal in France. It has provoked a lawsuit.

The French psychoanalysts come across in the film as blithering fools and they are none too happy about. Most of them speak at length about their theories of autism. They offer what I consider to be a fair rendering of their bizarre belief system.

And yet, three of them, the more Lacanian analysts, are suing the filmmaker for making them look like fools. They want their interviews removed from the film. They also want monetary damages.

I am not surprised. Free and open debate and discussion has never been permitted in the world of Lacanian psychoanalysis. Take my word for it.

I will tell you that Robert did not select a bunch of psychoanalytic cranks. Many of those she interviewed are pillars of the French psychoanalytic community, both from the Lacanian School and the IPA.

One might surmise that they were unaware of how foolish they looked until they saw themselves on film. Once they saw what they looked like they ran screaming into the night and decided to blame to the filmmaker.

In reality, they had agreed to be interviewed; they all signed releases. Most of them seemed to thrill to the opportunity to present their grand ideas to a larger public.

It’s one thing to sound like a fool. It’s quite another to be actively militating against effective treatment for autistic children. That is the charge that Sophie Robert levels against the psychoanalytic establishment.

In her film Robert shows that the French approach to psychotherapy is actively preventing autistic French children from receiving the most advanced and most effective current forms of treatment.

That, dare I say, is the rub. And it is not a theoretical rub.

Here is the way the New York Times presents the case:

“Le Mur,” or “The Wall,” a small documentary film about autism released online last year, might normally not have attracted much attention.

But an effort by French psychoanalysts to keep it from public eyes has helped to make it into a minor cause and shone a spotlight on the way children in France are treated for mental health problems.

The documentary, the first film by Sophie Robert, follows two autistic boys: Guillaume, who has been treated with the behavioral, or “American,” approach; and Julien, who has been kept in an asylum for six years and treated with psychoanalysis. Guillaume, though challenged, is functioning at a high level in school. Julien is essentially silent, locked out of society.

Since Sept. 8, when the film first became available on the Web, it and Ms. Robert, 44, have been the targets of criticism from both the analysts who appear in the film and from within the country’s psychoanalytic establishment. Three of the psychoanalysts whom Ms. Robert interviewed for the film have sued her, claiming she misrepresented them in the 52-minute documentary, which has not yet been screened in cinemas or on television.

Since the documentary is on Youtube I am offering it for your interest. It is in French with subtitles.

I will mention that the boy named Julien was not kept in an asylum. As I understood it, he was treated in a psychiatric clinic in a program where he spent his days in the clinic and his evenings at home.

If you watch the film you will see that Guillaume, while still autistic, is functioning reasonably well. He goes to school, gets fairly good grades, and requires only a minimum of extra consideration.

Thanks to the American “behavioral” approach, which his mother discovered on the internet, he will have a good chance to lead a productive life.

If you watch the film you should also pay close attention to Guillaume’s mother. If you keep in mind the psychoanalytic mania about blaming mothers you will be surprised to see how good a mother Guillaume has.

But, if it is so well established that the American approach provides better treatment why don’t all French children undergo it?

That is the real story here. And that is why Robert’s film has been so viciously attacked.

The film claims that the behavioral approach is simply not available to most autistic French children.

It is not available because it bears what French intellectuals consider to be a stigma: it comes from America. Therefore, it offends the cultural sensibilities of French psychoanalysts.

Since upwards of 80% of French psychiatrists learn psychoanalytic therapy, their influence is considerable.

Given the stigma attached to behavioral approaches to therapy, very, very few therapists are willing to risk their careers by learning it.

For French psychoanalysts it is not about effective treatment. It is about cultural purity. Lacanian psychoanalysis is a purely French production. Thus it must be preferred over the American behavioral approach that does not blame mothers and that actually works.

One French analyst even mentions with considerable pride that he and his cohorts have saved France from an “invasion” of alien American cultural influences.

It is a truly amazing statement, one made all the more amazing by the fact that the man who speaks it is oblivious to what he seems to be saying.

A psychoanalyst trained in a school that places special value on speech and language ought to weigh the implications of his words. He ought to know that when you say that you are actively fighting off an American invasion you are evoking an historical antecedent.

As everyone knows in 1944 allied armies did invade France. On D Day they invaded occupied France in order to liberate the nation from its Nazi occupiers.

Why Frenchmen would fear an American “invasion” is almost beyond comprehension. One day I will explain it, but not today.

Now, faced with the threat of an alien American invasion French psychoanalysts are fighting to prevent autistic children from receiving the best treatment available.

That they are doing it in the name of French honor and integrity renders us speechless.

Worse yet, Sophie Robert’s film has exposed them as fabulators, as perpetrating an intellectual con. In good French one might say that they come across in the moving looking like cons. (The word has an altogether different meaning and implication in French.)

Hello, i'm a french father of an autistic boy and a psychiatric nurse. Thank you so much for your analysis and your sens of humor.Maybe some psychoanalist french Doctors need a big cure of humor, instead of using psychoanalysis... including for themselves.

Dear Stuart,Thank you for your insightful analysis of the theories in the film. I believe that the American audience truly needed an expert opinion like yours to analyze it.We published a link to your blog entry on our English website Support The Wall

We will be in NYC on 26th afternoon for a press conference in Midtown Manhattan.

In the UK psychoanalytically trained clinicians and social workers are misrepresenting Autism and Asperger's Syndrome and preparing reports which lead to children from autism families being taken into care or offered for adoption. It's more subtle than in France but at least as frightening!

In the UK psychoanalytically trained clinicians and social workers are misrepresenting Autism and Asperger's Syndrome and preparing reports which lead to children from autism families being taken into care or offered for adoption. It's more subtle than in France but at least as frightening!

Thank you so much for writing about this, we need more awareness about our situation and we need America to know, to care, and to help, this is not something that can be done from the inside, not by "uneducated and gullible parents" as we are seen to be, we will never be taken seriously. The first time I saw my son's psychiatrist , and asked him how we would go about implementing ABA or some kind of social education for him, he laughed and asked me in a dismissive tone: "you have internet don't you?" having asperger's myself, I only understood that he was questionning my intelligence once I was back home...We need an invasion, we need help, we need you to care.

France is getting bad, in many domains, like psychiatry and education. Because our government does not do what he is supposed to do: ask experts for studies and apply the proposed solutions. The INSERM, a famous public French medical research center produced in 2003-2004 a report stating that psychoanalyis treats only 1 mental disorder out of 16 major disorders, though TCC treats 15 of them. But the government did not change anything in the way psychiatric people are trained in France. Our government officials (les fonctionnaires) do not do correctly their work.And French psychiatric doctors do not do what they are supposed (obliged) to do: read and learn every day for improving the way they help people to go better. They live as if France was the only country in the world.

About American invasions, we'd like to be invaded by ABA, TEACCH, PECs, rather than by CocaCola, Mc Donald, etc. ;) USA proposes to the rest of the world both bad things and good things. Like other countries do.

To respond to your point, I am well acquainted with several scientific and medical researchers in France.

I have never heard them disparage research studies because they were conducted outside of France. Most of them are in constant communication with fellow researchers in America, in England, in Japan... and so on.

The protectionist attitudes expressed in the film have absolutely nothing to do with science and are definitely not shared by French scientists... most of whom would be grievously insulted if you compared them to the analysts in the film.

We have a strange habit here in France, consisting in rejecting almost everything that comes from UK, Canada or the USA... except crappy music and junk food!!

I am not directly concerned by this specific issue, but, as many other "neurotypical" parents, I feel angry at these so-called "professionals" who do not want to admit that they could have done wrong and who are paid with our taxes!

We do need foreign support here and the fact that you had a lacanian training in another life is quite interesting : you know who you are talking about...

Thank you for your response.I did not say that psychoanalysts shown in the film are scientists, I said that scientists could be shown as ridiculous persons also.Protectionism is not a french invention, either!

For English-speaking readers who would prefer to read the transcript rather than watch the film, I have recorded the translated subtitles here. http://tinyurl.com/88a8kbjInteresting to hear that the court in Lille has found in favour of the psychoanalysts. To non-analytic types, it's hard to believe: the whole film seems like a spoof, so weird are the ideas of the analysts.I hope this experience will make the analysts look more thoughtfully at what they are doing: it's not just that they don't help the children, there are many parents who feel they have been damaged by this approach.

What’s really interesting is that the psychoanalysts incriminate her or his mother’s “bad parenting” for a kid’s autism, but the bad parenting they suggest (which I think is 99.9% of the time imaginary) is very, very mild compared to, say, parents abusing their children, beating them, etc… yet no-one, not even the psychoanalysts, has suggested or even observed that this much more extreme form of child abuse ever caused anything even resembling autism. How does that even make sense?

Are you sure you have understood any of lacanian teaching my dear? Have you survived shame? I does not seem so... Two remarks: are you sure that the person whom we see in that movie is really capable of bearing word 'father'? or is it just another child of 'good mother'. Has he spoken one word? Rings a bell? No, probably not, I see. And invasion... Yes, I absolutely hope that there be at least one nation that would not fall under american scheme of mankind - invasion and counter invasion. Great. I believe you must've read at least the 'Mirror stage' - you really cannot see any resemblance in it to what american society has become?

For those who are not following the story in France last week the Health Services, the HAS, declared that psychoanalysis is no longer an acceptable treatment for autistic disorders.

A group of psychoanalysts had a press conference last week also. I only saw part of it but they were insisting that they accepted the cognitive and behavioral treatments as long as there was still a place for psychoanalysis.

That's called a face-saving retreat.

Of course, they had nothing to say about the fact that their own attempts to stigmatize behavioral treatments has produced a situation where there are not enough of such practitioners in France.

Furthermore, they insisted that they had not been blaming mothers for autism, while they and others who follow the psychoanalytic orientation have always been blaming mothers.

That's called eating your words.

Finally, the most striking moment in the press conference came when Jacques-Alain Miller stated that there were hundreds of pages of testimony about the effectiveness of behavioral treatments and not one page of testimony about the effectiveness of psychoanalysis.

I did not get through the entirety of the conference, but still, when you have the leader of the Lacanian movement pointing to an objective fact that demolishes the claim that psychoanalysis has a use in treating cases of autism, then the debate is just about over.

It only remains for the court system to do the right thing and life the censorship of Sophie's film.

Antoine is thriving, but there is no doubt in my mind that he would not be the same child had we not made the decision to leave France in order to get him the help he needed.

I have definitely been following the story for several years now and did a happy dance when I saw last week's news, but I also suspect that it will be many years and another generation of lost children before things start getting noticeably better over there. For us, the experience was...well, traumatic would be an understatement.

I also know - from experience - that at least some of the psychoanalysts do indeed blame the mother for the child's disorder. Ours sure did, though several of them liked to harp on the "fact" that if I'd *just*stop*speaking*English* to him, he'd be fine. :-)

I'm very happy to hear that your son is thriving. It is positively frightening to think that there is a treatment that will help autistic children live productive lives but that it is not available in France because of the tyranny of the psychoanalysts-- where I come from it's called maintaining a monopoly.

I had never before heard of an analyst blaming parents for speaking English, though, as you say the psychoanalytic viewpoint has consistently been to blame the mother. One need but look at the film about Temple Grandin.

Anyway, in some of the outtakes for Sophie's film one of the analysts does say that it's the fault of the mother, but that she does not want to say so publicly.

Now the analysts seem to believe that the mothers' problems are all signs of a difficulty adjusting to an autistic child... as though all of the mothers who are accused of being too hot or too cold,too close or too distant, too devouring or too disinterested, too incestuous or not incestuous enough need to be treated because they are having trouble adapting. Huh?

The language is a language of accusation. Besides, the essence of Freudian psychoanalysis is making people feel guilty. Anyone who has missed that has missed the point.

Yes, as the American parent, I was blamed for a whole host of things by my son's psychoanalysts.

When he wouldn't draw his feelings for them (he was 3 and nonverbal), it was my fault. Nevermind that his fine-motor skills were severely lacking and once we fixed that he began to draw and write beautifully; our analysts in France did not want to discuss that. Instead, they said he was "blocked" and needed to spend less time with me (I had pulled him out of maternelle after his teacher slapped him, hard, on the first day of school - things went downhill from there until I removed him from public school altogether and began teaching him at home).

A variety of things were blamed on the fact that I spoke English to him; bizarre things, such as his spinning, stimming, constant lining of objects...

He was induced a month early (eclampsia) because I "rejected" him, I was told (well, yes, that's true, but maybe not quite in the way they meant).

The list goes on and on. When I politely declined psychoanalysis for myself, I was accused of making him unhappy with my own unhappiness. Yes, I was unhappy; these people were driving me insane!

Up to that point, I had no intention of moving back to the states and planned to raise my children there.

In other words, I have no axe to grind with the French. I love the country, the language, the culture, the people, my husband and children (French citizens, all), but was utterly blindsided by this. And all the more because their overall medical system is truly impressive; #1 in the world, and for very good reason. This is not some Third World country we're talking about.

It was an eye-opening experience, to say the least. But I will close by saying I was happy to discover your blog and this discussion. It's rare that I encounter an English-speaker who has any idea what goes on in relation to autism in France; I suspect that many believe I'm making our stories up entirely.

Thank you, Shari, for sharing some of the details about your own experience.

The people who are defending the Lacanians on this matter most often have no idea of what they are talking about. Most of them do not even understand Lacan. And they repeat the party line mindlessly. It's good to show them a little bit of the reality that you faced with your child while trying to find treatment through the French health services.

I also have developed an interest in the history of psychoanalysis and have been intrigued by the viciousness of the internal personal and theoretical conflicts that arose in this supposed vanguard of enlightenment. Does not surprise me that this theoretical fundamentalism continues in France. Thanks for your background info and the stand you are making against the excesses if the psychoanalytical movement inn France.Maurice Vaughan health economist and therapy critic New Zealand.

Not a single true statement about Lacanian technique is provided in this post. It makes me sad to read these polemics, which is exactly what this is, however well-intentioned it may be. I am going to watch the film with an open mind, and if it focuses on other schools of analysis then maybe the film is accurate. But fabrications about Lacanians in this post include the mother-scapegoat mania, the asylum environment or any other form of institutionalization, the talking cure (which does not apply to psychosis), the nationalist argument and WWII rhetoric is particularly ridiculous, and the statistics (worldwide) show that "developing" states rank higher than all western nations combined in the percentage of schizophrenic and psychotic cases treated affectively with holistic methods that have much in common with Lacanian approaches. Again, I can't speak for the other schools, so you may have a point about their methods. And we're all fighting for the same end here. It's insulting for either "camp" to lose sight of that.

Not a single true statement about Lacanian technique is provided in this post. It makes me sad to read these polemics, which is exactly what this is, however well-intentioned it may be. I am going to watch the film with an open mind, and if it focuses on other schools of analysis then maybe the film is accurate. But fabrications about Lacanians in this post include the mother-scapegoat mania, the asylum environment or any other form of institutionalization, the talking cure (which does not apply to psychosis), the nationalist argument and WWII rhetoric is particularly ridiculous, and the statistics (worldwide) show that "developing" states rank higher than all western nations combined in the percentage of schizophrenic and psychotic cases treated affectively with holistic methods that have much in common with Lacanian approaches. Again, I can't speak for the other schools, so you may have a point about their methods. And we're all fighting for the same end here. It's insulting for either "camp" to lose sight of that.

If you had been able to watch the movie you would have seen something about Lacanian technique-- but you can't because the Lacanians have censored it.

For some more information on the topic, this from the BBC, very recently:

http://www.bbc.co.uk/news/magazine-17583123

I'm assuming that your information about the treatment of schizophrenia correlates with the results suggested by Ethan Watters in Crazy Like Us, an excellent book.

To say that the Lacanian approach is holistic suggests that you know nothing about Lacanian technique. Dare I mention that I have published much material about it... and will soon be publishing some more.

To the person who noted that the talking cure isn't intended for psychosis (among other conditions):

Exactly right. Freud was quite clear about this, and stated his position on the matter often. It was Lacan, not Freud, who insisted that psychoanalysis could treat psychosis and other previously "off-limits" conditions.

I think both of these guys gave us incredible insights into the human mind, and I think that in France, psychoanalysis has to some extent become the disease it intends to treat. The practice has clearly been integrated into narcissistic defense mechanisms.

More concretely, how can anyone miss the narcissistic identification that these analysts (and many others) have through/with these kids?

At the time that Lacan suggested trying psychoanalysis or psychoanalytically inspired treatments on psychosis there was very little else available. In many other parts of the world psychiatrists tried psychoanalysis too. Eventually they all learned that the treatment did not work.

In France there were psychiatric clinics in the Loire valley, like La Borde, that tried a form of institutional psychotherapy that was inspired by psychoanalysis. One may question how effective it was, but those clinics prescribed every available psychotropic medication, as well as electroshock and insulin shock.

Thankfully there is a whole world outside USA which is more informed than this pseudo expert on the subject in question. Freud and Lacan's work is seriously studied and understood by eminent intellectuals and doctors / psychiatrists / psychoanalysts throughout France, South America, Canada, Spain, Italy and Germany, and psychoanalysis is alive and well without input from yankee pseudo scientists. With good reason we Europeans avoid you American warmongers. Everything you touch you destroy, and your arrogance has no limits. Keep your invasions to yourself - you are not wanted in the West.

Look, above poster, allow me to inform you on why your post is misinformed. In the methods of psychology that extended out of the behaviorist and cognitive perspectives we submit to scientific testing, we take our results, see their patterns, and report on that. The use of analysis is hard to verify scientifically, granted elements of it are effective particularly if one is referring to those carried into psychodynamic therapy used in an intensive treatment, but it is hard to produce comparable results.

The issue presented really comes down to use of analysis as a technique for children. Children with neurological issues that prevent them from reflecting in the manner a psychoanalyst could use effectively. That, plus the idea that this clearly neurological issue is really a manifestation of unconscious conflict with a mother is just not logical.

If we are to be scientists and treatment professionals we must accept the fact that science is something we must constantly progress. Analysis has its uses perhaps but it is not in the treatment of autism.

Any idea where I can watch the documentary with English subtitles? The one without them is public on YouTube, but the one with subtitles is private. Oh, and from what I read on a support blog for "The Wall", the ban on this film has been lifted as of January 2014. Link: http://www.soutenonslemur.org/

I have written about this in several places. See my website for a link to an article called That Night at Elaine's. I also wrote a bit about it in my book on Saving Face and in the new book on The Last Psychoanalyst.I have also posted on the question on my blog.

I suspect that just about everyone who was part of the movement is disillusioned by now. The real question will soon be, why is anyone not disillusioned?

Thank you for your comments and concerns about this issue. I am so admired with your book about Lacan which I remember was one of the first books I read about Lacan. From more a theoretical standpoint, what would you think if Lacan himself would say about autism, although you said you left psychoanalysis years ago.

Psychoanalysis is more about a family structure and because of that everything is referred back to family (mother and father's position), it seems more a theoretical thing to find the source of a child problem from the side of the parenthood. And I think you are fair to say "talking cure" may not be suitable for kid not able to speak about themselves. And I do support J-A Miller honest and scientific attitude.

One last comment is Lacanian is not always same as Lacan the person himself. And there is many Lacanian especially those who engage in child psychoanalysis is using object relations vision to treat kid. (What Klein talked about good or bad mother) There is hybrid of skills which not Lacan himself and his mission should be highlighted and blamed. It is generally a lack of theoretical understanding of autism for psychoanalysts today before they engage in a field that cognitive psychologists have done for decades.